tv [untitled] January 16, 2011 7:00am-7:30am PST
hello, i'm ivette torres, and welcome to another edition of the road to recovery. today we'll be talking about the importance of using prescription and over-the-counter medications properly. joining us in our panel today are dr. h. westley clark, director, center for substance abuse treatment, substance abuse and mental health services administration, u.s. department of health and human services, rockville, maryland; dr. timothy condon, deputy director, national institute on drug abuse,
national institutes of health, u.s. department of health and human services, rockville, maryland; dr. barbara krantz, chief executive officer and medical director, hanley center, west palm beach, florida; beverly gmerek, prescription drug abuse prevention program coordinator, peer assistance services inc., denver, colorado. dr. clark, how prevalent is prescription drug misuse in the united states? well, we estimate that there are approximately 15 million people who misuse prescription drugs in the united states, and that gives us an estimated 2.5 million new initiates per year, or, if you think about it, that's about 7,000 new initiates a day. and within that, do one age group uses it more than others? what is the distribution among the age groups?
well, i think the most important thing to keep in mind is that prescription drug abuse affects the entire age range. we might see some peak use in the 18 to 25-year-olds, but it is a problem that confronts every age range, and what we shouldn't do is to simply dismiss it as a young adult or teenage phenomenon; in fact, it's a problem that affects every age range. dr. krantz, where do most of the nonmedical users of prescription drugs get their drugs? most of the time nonmedical users of prescription drugs receive their drugs from friends or their medicine cabinet, their mother's medicine cabinet, from leftover medication. and those that do take it from the medicine cabinet or get it from a friend or a relative, the statistics, i believe, actually show that they're
getting it, receiving it from one physician, one doctor that's actually prescribing it. dr. condon, what types of drugs are we talking about? well, we've got a number of different classes, and we're always finding something new that people are abusing. but, generally, we have cns, or central nervous system depressants; tranquilizers, sedatives, that sort of thing; stimulants, very big prescription drug abuse, often used now, and we got a growing problem, as cognitive enhancers, performance enhancers; and opiod analgesics, widely prescribed for the control of pain, appropriately so in many cases, but we see that that's a source for a lot of the misuse or abused prescription opiates. dr. clark, what are the short- and long-term effects of the misuse of prescription drugs? you have to keep in mind that people take these medications for effect.
so if you take a prescription pain reliever, you are experiencing some euphoria. if you take a sedative, you are experiencing some tranquilized effect. but a lot of this is complicated by the fact that people mix these medications when they're not designed to be mixed. they add alcohol to these medications, and that's not designed, that's not a designated purpose. so when you're looking for the short-term effects, while you may be trying to get high or euphoric, you may wind up having a short-term effect called death because people often overdose on these medications, because they underestimate the power of the medications. they are prescribed by the physician to the designated patient for the condition that the designated patient presents with when they see the physician. they're not prescribed for somebody else, and so- nor are they prescribed to have a party,
and we occasionally have people who overdose, and we're seeing that a lot with prescription opiates. people overdose because they underestimate the power of the medication. are most of the overdoses when, is when the medication is misused or is improperly taken while it is prescribed or both? well, if it's improperly taken when it's prescribed, it's misuse. so the idea is mostly overdosed deaths are associated with nontherapeutic purposes or nontherapeutic procedures. so that's the key issue that a person is either augmenting when they shouldn't be or they're taking something that was never designed for them, designated for them in the first place. so one of the reasons we get the message out is because in some jurisdiction if you give somebody a pill that they overdose on it, even if they had alcohol or something else, you're held criminally liable. so not only are you- you contribute to somebody else's death or hospitalization,
you can be held criminally liable. i think that's a really important point that most people don't understand. as we know, a lot of adults share their medications out there, and they don't understand there can be legal repercussions from that, not to mention the physical. i mean, that's something that people are not aware of. this can be deadly. and not only is it deadly, it can be just as illegal as sharing illicit medications as well. and that's a point that the general public doesn't seem to understand very well. that brings me to another point because when the- we treat older adults in our facility, and the problem is when the client comes in, the patient comes in, they're probably on about four to five different prescription medications. so the drug-drug interaction of the prescription medications, and they may be seeing different specialists, like they're seeing a cardiologist, a urologist, a family practitioner,
none of them are talking to each other, so the drug-drug interactions and the potential for the morbidity or mortality that dr. clark was talking about is extremely high. just because it's a prescription drug doesn't mean that it's a safe drug. and i think where, you know, you add over-the-counter medications and other medicines or herbal medications to that, and we're seeing a very serious problem with prescription drug abuse. one of the things also that just was touched upon is that individuals at different age groups, and we know this from pharmacology, they metabolize the drugs, medications, drugs differently. and a dose that was tested in a young adult, let's say, for a particular purpose, may not be metabolized the same way by an elderly person, in fact, it's unlikely that it is.
so the same dose may have a very different effect, and that's where this combination or drug-drug interaction actually comes in, and oftentimes we do see, unfortunately, the headlines when it's somebody who's a star or a celebrity, but that's where a lot of this is coming. i recall that a few years back, i would say around four or five years ago at csat we did do the right dose, for the 65 and over. we had two; we had the 50 to 65 because we thought that they would not identify with a picture of an older adult. and then we did the 65 and over, and we worked with fda. and in one particular thing that you said, dr. krantz, was the use and the mixing of it with alcohol, which is absolutely tragic. right. and i think brings us back to it's extremely important to educate the patient, to educate the physicians, and to educate the patients
regarding the use of the medication, and i think with prescription drug medication, like dr. condon was saying also, is that, as people age, the normal physiological changes that occur with aging, the drug itself, because there's a volume distribution, the drug itself has more impact on the body. so that needs to be taken into consideration also as far as education. i think one of the things that we also want to establish here is that prescription drugs, if taken properly, are beneficial. i think-but that really leads to the fact that they can see the benefit. why might people believe then that prescription drugs are not dangerous or addictive? i think that there's the myth if it's good for dr. condon, then it's good for me.
and so he takes it, then, gee well, i can take it; but dr. condon would have had it prescribed by a physician for the purpose of, for that designated purpose. i, on the other hand, don't have that issue, so i take it, and, boom, i get an overdose, or somebody else is taking the medication for a period of time, and they take that dose and nothing happens. i take the same dose, and, boom, i'm out. but we also have to keep in mind, driving while under the influence. i take that dose, and the next thing i know i'm woozy, i get behind the wheel of a car, and i hurt somebody, if not just myself. so the key issue is, the other person for whom it's designated doesn't have that experience. and so they, you know, it's safe for them. i can bring that to a personal level also, with prescription medication-is that back in 1981,
i had migraine headaches and was prescribed a narcotic, an opiate, specifically demerol, and started taking the medication. and as you continue, potentially, as you continue taking the medication, when we look at the disease of addiction, there's a progression, it's a chronic disease. we go from use to abuse to dependence. so then as i started taking more of the medication, i actually became dependent on a prescription drug. so for me it wasn't safe anymore, and, quite honestly, i didn't understand what was going on. i knew that there was a problem. i knew that i was in trouble, but i didn't understand. when we come back, i want to come back to you, dr. krantz, and talk a little bit more about this. and then we're going to talk about another set of medications, which are over-the-counter medications, which are also on the rise in terms of its misuse. we'll be right back.
(music) it's important for us to realize that roughly 70 percent of individuals who misuse prescription drugs get those prescription drugs from friends and family; 55 percent get them free from friends and family; another 15 percent either buy them from friends and family or steal them from friends and family. so the key issue is that what we have to do is influence our communities-it's a cultural issue- influence our communities to get people to understand that once you're finished with a prescription drug or if you need the prescription drug on an ongoing basis, you do not share them with individuals for whom the prescription was not written.
when you have a drug or alcohol problem, your whole world stops making sense. you can get help for yourself or a loved one and make sense of life again. for information, treatment referral, and, most importantly, help, call 1 (800) 662-help. brought to you by the u.s. department of health and human services. people who suffer from drug or alcohol addiction sometimes say hurtful things. they drive the people who love them most away. if you know someone who suffers from drug or alcohol addiction, listen. try to hear what they are really saying. know that there is hope, and help them find their voice again. for drug or alcohol treatment referral for you or someone you know, call 1 (800) 662-help. brought to you by the u.s. department of health and human services.
(music) having first-hand knowledge, personal experience with the disease of addiction, it has been extremely helpful in my treatment of patients. you know, patients come in scared, a lot of shame, and when they're going through, even initially, the withdrawal process they may say to me, "you know, you just don't understand how i feel." and that gives me a great opportunity to tell them, not only do i know how they feel, i have the personal experience as well as the book knowledge to help them. and there is help. dr. krantz, you were talking about your own experience with a very potent medication.
did you have a sense of a perception of safety while using it? well, the drug itself used properly is a safe drug and an effective drug. what happened to me was i increased the frequency of using the drug and the amount that i used and then, because of the biochemical genetic trait that i wasn't aware of, actually became dependent on the drug. so prescription drugs certainly are safe if used, and effective, if used as prescribed. that's assuming that everybody's going to follow the physician's directive, correct, beverly? that's correct. and i think we have to take a look at the prevalence of prescriptions in today's society and how that's changed among the public perception with a directed consumer marketing and advertising over the last 10 to 12 years.
we're seeing more prescriptions out there, and they're treating more conditions and that's fabulous, and we need to use those as directed and as safely as possible. but in that same refrain, we've taken medications that we used to maybe have a lot of respect for and treat them, you know, as something to be respected, and we've made them commonplace among our youth; you know, $4 medications, while those are fabulous, those ads are making this just as easy to do as a soda that you get in a drugstore and 7-11. for instance, my daughter, when i put her to bed, my four-year-old, couple of years ago, looked at me and said "when is the night-night butterfly going to come?" and that's from seeing the lunesta commercial that was quite popular at that point in time. so we've changed the way we think about medications with the marketing and advertising and given them more of an assumption to be safe than they were many years ago. so i think that's something to think about as we're discussing this.
and what does a parent say to the child when that occurs? well, you know, as a parent, it's very difficult because you give your child medication and say, here, this will make you feel better. and that, again, is giving a mixed message to our children and to our youth that taking a medication is always going to make them feel better. and we need to explain to them that taking a medication is there for a specific purpose, a specific reason, to treat a specific condition in their body in order to make those germs, you know, go away so that then they will feel better. so it's changing the perception in the way we're talking. dr. condon, as beverly was mentioning, there's not only the advertising but some of the young children and young adults and youth also get a lot of medications, very, very potent medications. in what instances might they, might they face an encounter with these? well, overall in the country, we are seeing,
have seen for the last couple of decades, a dramatic increase in prescriptions for controlled substances, stimulants and opiate analgesics, and cns depressants, and so we do-have had this whole culture change. i agree very much that we treat medications differently, and that has a double-edged sword. it's good and bad that people are not afraid to take medications that can be lifesaving. at the same time, are we sending the wrong message? so, with the increase in prescriptions that we've seen, young people, for example, we see more prescriptions for opiate analgesics related to dental care for young people. and that's their first experience, usually, with an opiate analgesic when they have some kind of root canal or extraction, usually with their molar extraction procedures.
also, stimulants are a big issue, for- appropriately prescribed for attention deficit disorder, but we're probably overprescribing in the country for adhd because all children are not being appropriately diagnosed with real adhd, where these medications can be very, very helpful. dr. clark? we also have the notion of the sharing, the earlier point made by dr. krantz in terms of people sharing the medication. you get the drugs from friends or family. there's a cultural thing that somehow sharing your medication is permissible even though the person who's getting the medication is not using it for a therapeutic purpose. when you add the number of people who get it free from friends and family, plus the ones who take it from their medicine cabinet or who buy it from friends and family, it's 70 percent.
so we are talking here a cultural phenomenon. we know about the internet. it turns out there are minority people who get their drugs from the internet. we know about drug dealers. it turns out a minority of the people get their drugs from drug dealers. we know about doctors who are not acting in good form, but a minority of people get their drugs from those. so in the aggregate, only 30 percent of the misuse of prescription drugs come from, shall we say, deviant situations, with 70 percent comes from friends and family. so part of the message is that the community has to be actively involved in discouraging the misuse of these medications because it is a community value and a community norm and a community message, and if we don't deal with that, then we essentially encourage people to misuse prescription drugs with the mythology that it's safe even though the medication is only safe and effective for the intended use or the intended person. and beverly, what is message to the youth in terms of-
from a prevention perspective? i think we need to let them know that medications can only be used as prescribed for that specific individual, and it is something not to be abused and not to be mistreated. i think to our adults and to the parents and to the grandparents out there, we need to let them know that they need to take their medications and their prescriptions and treat them as they would their cash, their credit cards and put them in a safe location and so that they're not something to be shared, just the way we don't share our social security number. i also think-i want to go back to your point about the dental pain and the dentist. we talk a lot about our medications. if you have a 16-year-old that goes to the dentist to have their wisdom teeth pulled, when they go to school the next day, their friends go, "so what drugs did you get," you know. we need to learn that we don't need to talk about what pain medications we're taking or what medications we're taking with anyone other than our pharmacist and our physician. we don't need to share that information.
i was at a health fair recently, and i had a seventh grader come up, and we were discussing different medications, and she said, "oh, my dad just had surgery; he's got vicodin." well, she just informed all of her peers around her that there was vicodin in her home, you know, which allows her to go then share them. then she had a lot of friends come over to her house. a lot of bffs. that's right. but there was no reason that seventh grader needed to know her dad was taking that specific medication, you know, and it's just, it's become such a casual thing anymore. we need to treat it with a little bit more respect. and we've just really scratched the surface because there's a whole cadre of medications that are controlled substances, and then we have the over-the-counter medications, and we know that also the over-the-counter abuse in the united states is quite prevalent. right, dr. clark? well, we know that they're common.
we collect data. i think tim can speak to the specific data for the age range, particularly, our young people who abuse drugs that contain cough suppressants like dextromethorphan. there are a host of other drugs containing phenylpropanolamine, diuretics, laxatives, which particularly young girls who are struggling with body image, drugs that cause emesis, throwing up. but the drugs that contain dextromethorphan used to get a buzz on also contain alcohol at times. so kids take multiple doses instead of the therapeutic dose. like prescription drugs, the over-the-counter drugs are safe and effective when used as indicated but- and, also like prescription drugs when misused, you get a different effect, a different response. tim? you know, the other over-the-counter that we
actually haven't touched on here is inhalants, which is a huge problem, especially in our younger grades. i mean, our monitoring the future survey shows that it's kind of the reverse, the 8th and 12th graders reversed. the 8th graders use more inhalants than the 12th graders do. and so that's some of the first and early exposure for these things that are readily available in the drugstore, art store. well, when we come back, i know that we've just scratched the surface on the over-the-counter because that is something that's even more accessible to the younger populations, and they can just go up to the drugstore and acquire it. and so i want to talk about what some of the preventive measures we can take, you know, not only parents can take but pharmacies as well. we'll be right back. (music)
it's important to be familiar with the proper terminology surrounding addiction and recovery. one of the terms you want to be familiar with is substance use disorder. substance use disorders involve the dependence on or abuse of alcohol and/or drugs, including the nonmedical use of prescription drugs. for more information on this and other recovery jargon, visit the recovery month web site. (music) drug and alcohol addiction. you lose your way. but there is a way out. you can find direction.
find support, treatment. find yourself, and your life. your direction home. for drug or alcohol treatment referral for you or someone you know, call 1 (800) 662-help. if someone you love has a problem with drugs and alcohol... "he's not expecting this." "yeah, but it's the right thing" ...there is something you can do. "you think he'll be ok with this?" "shhh, here he comes." "congratulations!" you can celebrate his recovery every chance you get. for drug or alcohol treatment referral for you or someone you know, call 1 (800) 662-help. (music)
today, we're a medicated society. and that means that prescription medicines and over-the-counter medicines are literally at arm's reach. in fact, people ages 65 and older, in any given year, are filling more than 30 different prescriptions. and one third of older adults are using five different medicines at the same time. the mission of the national council on patient information education, ncpie, is to stimulate and improve communication of information on safe and appropriate medicine use to the general public and health care professionals. "thank you for inviting the national council on patient information education,
ncpie; that's how i'm going to refer to us today." one of our key programs right now is called the "teen influencer" program. the full title is "maximizing your role as a teen influencer: what you can do to prevent teen prescription drug abuse." that program enables adults in the community to access and download and then use for community outreach purposes a whole range of materials to help get the word out in a consistent way about prevention and treatment options related to teen prescription drug abuse. as medication use becomes more prevalent in our society for all ages, so too becomes the need to improve the communication about those medicines between the clinicians-the doctors, the pharmacists, other prescribers-and the patient and their support network. samhsa's been a tremendous resource support to ncpie. they've provided resources and also the intellectual